3 The personnel system and the AF Form 469Recommend to commander restrictions for Duty Limiting Conditions (DLCs)Notify MPF of assignment defermentsNotify MPF of deployment defermentsNotify MPF of TDY defermentsNotify MPF of enlistment eligibilityNotify MPF of blocks to retirements / separationsMedics are now responsible for personnel codes (31, 37, & 81) that govern items in red. We are also responsible for the fall out if we do not use the personnel codes correctly.

4 Assignment Availability Codes (AAC’s)Codes used to manage personnel actions during a member’s current assignment.Not meant to be long termConsidered deferments but can be waivedGiven by numbers AAC-2 through AAC-85 (AFI table 2.1)AAC-31 (Medical deferment for rehabilitation)OPR MTFAAC-14 (Material witness)OPR SJAAAC-50 (CONUS Maximum Stabilized Tours)

5 AAC 31 Temporary Medical Deferment“ A member may be temporarily deferred from PCS or TDY when accepted medical principles make it evident that a physical defect which prevents worldwide service is temporary and should be cleared within 12 months” AFICannot load assignment that falls during the deferment. Can load RNLTD for after expiration date.Triggers Deployment Availability Code (DAV) 41

6 AAC 37 Medical Evaluation Board and Physical Evaluation Board Deferment“When a member has a physical limitation which may not be temporary, the MTF provides the MPF and HQ AFPC/DPAMM an AF Form 422 indicating that an MEB, which could result in a PEB, is being processed…a member pending MEB or PEB may not be reassigned PCS or TDY (or granted leave outside the local area, separated or retired) until after the MTF determines the medical disposition.” AFI

7 AAC 37 Medical Evaluation Board and Physical Evaluation Board DefermentMilPDS will reject attempts to load an assignment as long as member is on a code 37.Triggers a “4K” reenlistment ineligibility codeThis DOES NOT fall off if code 37 allowed to expire*Something to consider with new DES procedures.Triggers a DAV 42

9 Identification : Conditions not compatible with worldwide mil serviceWhat about “profiles” for “unsuiting conditions”“Do not use medical profiles to code administrative conditions that render a person unsuitable for duty as opposed to unfit for duty. In this situation it is important to use the AF Form 422 to communicate impairment with command but the S profile should remain unchanged.” Substance abuse / dep excepted (AFI V4 A4.3)

18 DAWG and the MEB Long term - ready for MEBPEBLO, SGP, SGH, + one doc stay after DAWGCase packages should be complete!AF618 partially filled outMust look at full package. Does CC letter, AF469, and narrative make sense? Are they current? Are the consults required by present?Write in findings on AF618 (EPTS, LOD, service agg, etc) and decision (RTD vs. Refer to IPEB), sign.

19 PEBLO and MEB disposition“Return to Duty” – Send case to DPAMM. We may send some to IPEB (10%) but most RTD with an ALC-C“Refer to IPEB” – Destination depends on facilityPEB Referral Hospitals (Designated by list. Can do their MEB at their own facility and send to AFPC). PEBLO sends to DPSD (Disability Division)Non PEB Referral Hospitals (Not on list. MEBs sent to PEBRH for MEB / PEBLO) PEBLO sends to DPSD. In practice, old exception loop now standard. PEBLO sends case to DPAMM. If complete, we send to DPSD. Some we may just assign ALC-C (15%)

22 Informal Physical Evaluation Board (IPEB)Two main decisionsFitness for further military serviceDisability ratingFitness determined by “weight of evidence”For most AFSC’s, “fitness” determined mostly by ability to perform in-garrison dutiesFor combatant / high ops tempo AFSC’s, many can be found unfit due to “deployability” aloneCC’s letter, Narrative, and AF 469 most heavily weighedIf determined “fit” mbr may contest. Case reviewed by Chief of Disability. May be sent to Formal PEB or may not. If “fit” finalized, it is sent to DPAMM

23 IPEB “Return To Duty” DPAMM actionDPAMM evaluates for ALC-C off matrix of risks to member mission vs. severity of riskAlmost all conditions falling afoul of AFI V2 A2 will require an ALC-C, few exceptionsDeployability standards in AFI V4 A5 set the “floor”. If cond exceeds that, SM will be a min C-1.If unable to wear protective equipment or uniform, member is a C-2 minimumC-3 usually for unstable conditions and / or those requiring frequent specialty careAfter Form 4 (from DPAMM) arrives at MTF, REMOVE CODE 37 & DO NOT MARK 31 BOX.

24 IPEB “Unfit” findingIf “unfit”, case is rated for disability percentage using the Veterans Administration Schedule for Rating Disability (VASRD)* Title 10 guidanceI0% increments from 0-10020 or less, decision is severance pay30 or greater, decision is permanent retirement if condition is stable.30 or greater but unstable, decision is Temporary Duty Retirement List (TDRL)

25 Veterans Administration and DisabilityDisability guidance under Title 38Members separated or retired from the military can receive VA disability IF eligible AND they applyAward disability for any medical disability incurred while on Active Duty, NOT just UNFITTING.Disability monthly payment based only on percentage.Range $117 (10% no dep) to $3000 (100% w dep)

27 Formal Physical Evaluation Board (FPEB)The FPEB is a branch under the Disability Division at AFPC. Separate and distinct from IPEB. Located at Lackland AFB. More “legal” format.3 person board. Member present. Attorneys present.President – Personnel OfficerLine Officer0-6 PhysicianDecision approved by the Chief of Disability DivisionSame decision but this time if mbr contests “unfit” finding with written rebuttal, case sent to SECAF/PC.SECAF/PC decision is final. Appeal to BCMR as a civ

28 Interim Summary AF Form 469 conveys more than work restrictionsWe are now the personellistsCode 37 as soon as need for MEB is determinedMEB after OMB and required consults completeMedical Standards Branch (DPAMM) is not the same as the Disability Division (DPSD)Physical Evaluation Boards fall under DPSDIf ALC-C is assigned, no 31 or 37 on AF Form 469

29 Processing Time Line Most confusing item about the DLC / DESMany sources of guidanceRemember intent of the AACs to guide actionsWe need to nail down in

30 Processing Time Line AFI 41-210 Conundrums?– “Refer the member for MEB action within 30 days after a complete work-up and a definitive diagnosis has been made. During the medical work-up, ensure the member is placed on a 4T profile.NOTE: Do not mark the MEB block on the 4T profile if the evaluations are incomplete and a determination cannot be made that the member requires a MEB processing.”

32 Processing Time Line When to MEB?As soon as optimum medical benefit has been reached and all consults completed, narrative must be completed and case referred for MEB ( E3.P1.6.1 & E3.P2.1.1, AFI (30 days), time for MEB set by DAWG?)From date narrative is complete, full package has 30 days to get through MEB, mail, and arrive at AFPC. (DoDI E3.P , AFI , and & )* Consults * must be less than 90 days old (AFI )

33 Processing Time Line AFI 48-123 OMB vs. 90 day?A “Individuals sustaining a myocardial infarction will have MEB processing within 90 days”A “Member has undergone coronary vascular surgery, regardless of result…NOTES: Conditions above must have MEB processing within 90 calendar days of surgery…A “Sz disorder A …for AD, MEB within 90 days of first episode.”A “Diabetes, diagnosed…MEB…in 90 days.”A2.19 “Tumors and Malignant Diseases…NOTE: All members with neoplastic dx…MEB within 90 days of initial dx or as soon as condition has stabilized.*In 1987, MEB could recommend “return for further care”

34 Processing Time Line AFI 10-203 deadlines?2.7.3 “Deploying or TDY physicians…unable to complete MEB NARSUM and case coordination within the 30 days allowable are required to transfer responsibility for their duties to another provider.”2.8 “Clinical Consultants. Will provide timely…narrative summaries…accomplished within 14 days of patient encounter…may be delayed if sig studies pending but will never exceed 14 days following definitive diagnosis.”“For members on a code 37…Cases exceeding 90 days from initiation of the MEB will be reviewed for progress and impediments to completion.”

35 Summary Many sources of guidance on time lines and it is growing.Narrative must be less than 30 days old when MEB package arrives at AFPC.Time sensitive consults must be less than 90 days old.Review cases with 90 day time line every 90 days… but case must be at OMB before it can be sent to PEBsIncorporate time line into